Ambulatory diagnostic ECG monitoring for syncope and collapse: An assessment of clinical practice in the United States

David G. Benditt, Wayne O. Adkisson, Richard Sutton, Robin K. Mears, Scott Sakaguchi

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Introduction: Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States. Methods and results: A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting-cardiologists, n = 35). Depending on specialty, respondents reported that neural-reflex and orthostatic causes accounted for 17–23%, cardiac causes for 12–20%, and “neurological causes” (specifically psychogenic pseudo-syncope/pseudo-seizures and acute cerebrovascular conditions) for 7–12% of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25% of respondents chose an AECG technology other than a Holter-type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18% indicated that they would choose a 24- to 48-hour Holter, 20–34% would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65% would select an insertable cardiac monitor. Conclusions: In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline-based recommendations.

Original languageEnglish (US)
Pages (from-to)203-209
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Issue number2
StatePublished - Feb 2018

Bibliographical note

Funding Information:
Dr. Benditt is a consultant to and holds equity in Medtronic Inc. and St. Jude Medical Inc. Dr. Adkisson serves on an adverse event panel for a Medtronic Inc. clinical trial. Dr. Sutton is a consultant to Medtronic Inc., serves on a Speaker's bureau for St. Jude Medical, Inc., and holds equity in Boston Scientific Inc. and Edwards LifeSciences Inc. Robin Mears is a Medtronic employee and has no other potential conflicts. Dr. Sakaguchi is a consultant to Biotelemetry, Inc.

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.


  • ambulatory ECG monitoring
  • collapse
  • syncope


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